Effect of metacognitive therapy on negative symptoms: a case series
Research type
Research Study
Full title
Investigating the impact of a six session meta-cognitively focused therapy on individual negative symptoms: A Single Case Experimental Design Study
IRAS ID
256369
Contact name
Hamish McLeod
Contact email
Sponsor organisation
NHS Greater Glasgow and Clyde
Clinicaltrials.gov Identifier
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 10 months, 31 days
Research summary
Summary of Research
Negative symptoms (e.g. diminished pleasure and motivation) are common in people with a diagnosis of schizophrenia. Little is known about the psychological mechanisms involved in negative symptom development and maintenance and there is limited evidence for current treatment options. Some research suggests that difficulties with metacognition; the capacity to develop and use complex ideas about oneself and others, may predict experiences of negative symptoms. This study will investigate whether a structured, six-session psychotherapy targeting meta-cognitive processes improves metacognition in people experiencing negative symptoms, and if metacognitive changes lead to observable differences in behavioural manifestations of negative symptoms (e.g. low activity levels).
We will collect data via standardised assessments of metacognition and negative symptoms. Activity levels will be measured with actigraphy, which has been shown to capture differential activity patterns for individuals who experience negative symptoms compared to control groups. We will also examine whether improvements in specific aspects of metacognition (e.g. self-reflectivity) relate to changes in individual negative symptoms, such as motivation levels, and other markers of personal change, including personal and social performance, insight, and beliefs about recovery. Additionally we will report factors that may have impacted on the study results, such as therapist adherence to the treatment. Eligible patients with capacity to consent will be recruited from the inpatient rehabilitation psychology services at in NHS Greater Glasgow and Clyde. They will be aged 18 or over, have a schizophrenia spectrum disorder diagnosis, and experience current negative symptoms. The target sample size is up to 6 patients. Participants will measured at baseline and will receive up to 6 sessions of the treatment approach. Any therapeutic change will be observed via changes from assessments at baseline to the assessments in the initial, middle and last therapy sessions.
Summary of Results
What was the project called?
Understanding the impact of a six-session psychological therapy on negative symptoms
Who was involved in the study?
This research was carried out by Dr Nicola McGuire, Dr Rachel White and Professor Hamish McLeod in affiliation with and sponsored by the University of Glasgow, School of Health and Wellbeing. It would not have been possible without the participants who took part. We are so thankful they were willing to provide their time and thoughts, as well as try something new by participating in the therapy.
Important statements about the project:
This project was awarded a maximum £250 budget for costs incurred through the main researchers’ participation in the Doctorate of Clinical Psychology. This course is funded by NHS Education for Scotland (NES). NES played no role in the research design, conduct or write up processes. The researchers involved in the study report no competing interests. The study involved the contributions of two people with lived experience of mental health difficulties to the wording of the participant information sheet.
Why was the research needed?
Negative symptoms are a set of difficulties commonly seen in people experiencing psychosis. These include experiencing less motivation and pleasure, seeking less social activity, and using fewer emotional expressions, gestures and language. Difficulties with metacognition (the ability to think about one’s own thinking about the self, others, the world and how we respond to psychological problems) have been found in people with negative symptoms and may contribute to negative symptoms remaining a problem. This study was originally developed in 2019 and it evolved a lot due to resource challenges. The final aim of the study was to explore whether a six-session psychological therapy targeting metacognition was acceptable to participants; was feasible to deliver; and was capable of creating change in metacognition (evaluated through therapy transcripts) and therefore negative symptoms.
What happened during the study?
An original attempt to recruit participants to the study was made in 2020 which was halted due to the onset of the COVID-19 pandemic. The study was adapted and restarted in 2024 and took place in inpatient mental health rehabilitation wards in Glasgow. To do this, individual people were recruited to different study conditions (i.e. how long before receiving treatment was varied). This is called single-case experimental design, and it allows greater confidence that when a change is observed, it is the result of the intervention, instead of improvements that person may have experienced over time anyway.
The study recruited 3 people who met study criteria (being 18+; receiving mental health care from inpatient rehabilitation psychology; having a psychosis-related diagnosis; and whose scores on a negative symptoms measure were classed as moderate to severe). People who had negative symptoms which appeared to be caused by other psychosis symptoms were not eligible to take part. Everyone who took part provided informed consent to participate. People were asked to wait a randomly selected amount of time before beginning therapy, and theirs and researcher’s ratings on questionnaires and interviews across the study were compared to see if there were changes in their symptoms, functioning and sense of mental health recovery.
What were the results of the study?
Those recruited did not drop out, suggesting the treatment was feasible. Their relationship with the therapist improved over time, suggesting the treatment was acceptable. It was also feasible to rate metacognition with therapy transcripts. People found completing the research measures tiring and repetitive, and this might explain why people provided less varied responses over time, and decided not to wear a watch designed to measure physical activity. Most study measures showed people experienced improvement, for example improved metacognition and less experiences of negative symptoms, but watch data were hard to evaluate due to lots of missing data. Some statistical analysis was carried out, but confidence in these results is limited because of these issues. Most of these analyses did not identify any statistically significant changes.
How has this study helped patients and researchers?
This early-stage evidence suggests that metacognitive therapy for people with negative symptoms was acceptable, feasible, and showed benefits. Researchers should continue to investigate therapies for this group of people. However, understanding and improving on what made the study challenging for participants is an important learning point from this study.
Where can I learn more about this study?The results of this study are published as part of the primary researcher’s thesis in fulfilment of the doctorate of clinical psychology. This is available on the University of Glasgow’s Enlighten thesis repository.
REC name
West of Scotland REC 5
REC reference
19/WS/0090
Date of REC Opinion
25 Jun 2019
REC opinion
Favourable Opinion